The effect of modified surgical flap design for removal of lower third molars on lingual nerve injury

The objective of this study was to evaluate a modified flap design for removal of lower third molars with avoidance of lingual flap elevation and its effect on postsurgical lingual nerve sensory impairment. The patients included in this prospective study were those referred for removal of symptomatic lower third molars at two Oral and Maxillofacial Surgery clinics. Different patterns of impaction were included regarding the angulation and depth of the lower third molar. Patients were reviewed 1 day after surgery, then after 1 week. Each patient was examined at each recall visit for any sensory alterations of the lingual nerve. The data collected was correlated to several variables including the age, gender, side of operation, state of eruption, angulation, depth of impaction, and tooth division. A number of 53 patients (23 males and 30 females), at ages ranging from 16 to 43 years, underwent surgical removal of 66 fully or partially impacted lower third molars under local anesthesia using a modified flap design. The modified flap design provided adequate exposure for removal of the lower third molar for all patterns of impactions included, regarding the state of eruption, angulation, and depth of the tooth. This study showed that the investigated flap design can be safely used to remove lower third molars for different patterns of impaction without jeopardizing the lingual tissues thus providing optimum protection for the lingual nerve since it provided adequate exposure to remove the tooth without the reflection of a lingual flap.